Melanoma. Skin cancer

"Along with surgery, there are medical treatments that improve the prognosis of patients. In recent years there have been significant advances".

DR. PEDRO REDONDO
CODIRECTOR. DERMATOLOGY DEPARTMENT

Melanoma is a skin cancer, one of the tumors with the highest incidence in humans. However, we must emphasize its preventable and curable nature.

In recent years, the number of cases has increased alarmingly, possibly in relation to sun exposure habits. 

It originates from the skin surface, specifically from melanocytes, the cells that give the skin its dark color. In general, they can be easily visible.

The Dermatology Department of the University of Navarra Clinic has the most advanced technology for the diagnosis and treatment of this pathology.

In addition, our specialists are experts in performing Mohs surgery, a highly complex microscopic technique that provides better healing results than conventional techniques.

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What are the symptoms of melanoma?

Melanoma manifests itself in most cases as a previous pigmented lesion (nevus) that begins to grow uncontrollably.

When a nevus meets a series of requirements, it is necessary to go to the doctor. This is the rule A,B, C and D:

  • A. Asymmetry. When comparing one half of the nevus to the other, they look different.
  • B. Edges. The edges are irregular, appearing staggered.
  • C. Color. Variety of coloring, with brown, black or blue parts.
  • D. Diameter. It is rare that the diameter of a nevus is less than 6 mm.

Do you have a spot on your skin that worries you?

You may have a melanoma

What are the causes of melanoma?

Excessive sun exposure and genetic factors are the main causes of melanoma.

Therefore, both excessive sunbathing and the presence of a family history of skin cancers are reasons to get checked.

In this way, pre-malignant lesions or those nevi that present alterations that suggest an incipient malignancy can be removed early.

The solar radiation causes damage to the DNA of the cells, which when not repaired by the intracellular machinery, creates a mutation in the cellular genes that expands without control.

When the skin is exposed to the sun, melanocytes produce more pigment (melanin) with which the skin tans or darkens.

They are more at risk for the disease:

  • People with light eyes, white skin and blond or red hair
  • Those who perform outdoor occupations
  • Those with a history of frequent sunburns in childhood and/or adolescence
  • Patients with severe sun damage and/or multiple actinic keratomas

What is the prognosis of melanoma?

As with other tumors, the best prognosis is achieved by early removal of the tumors. To identify them, it is essential to have frequent periodic controls.

Although there is usually a direct correlation between the lower thickness of the tumor and the best prognosis, in many cases, this relationship is broken and early metastases appear in people with a small degree of tumor depth.

In the initial phases, when it grows on the surface and does not infiltrate the skin, melanoma has an excellent prognosis and is cured with simple surgery. When it grows in depth, the prognosis worsens and the possibility of spreading to other areas of the body begins, initially through the lymphatic route.

How is melanoma diagnosed?

Physical examination and biopsy are the main diagnostic tests.

The Dermatology Department of the University of Navarra Clinic has the most advanced technology for the diagnosis and treatment of this pathology, such as dermatoscopes with epiluminescence.

In addition, we have a new diagnostic technique for the early detection of melanoma which consists of an automated full body mapping of the entire body surface of the patient, in order to automatically detect the presence of a new mole.         

The application of new technologies allows melanoma diagnoses to be made earlier every day, which results in an increase in cures or overall survival.

How is melanoma treated?

In the Clinic we are specialists in Mohs surgery, controlled under the microscope. It is a technique of great complexity and specialization, but it provides the best results.

This technique is very delicate and requires very specialized personnel. It is applied in cases such as large neoplasms, with a long evolution time or in those with several local recurrences due to incomplete removal.

The Department of Dermatology of the University of Navarra Clinic has great experience in this type of surgery. It provides the highest rate of cure, compared to traditional techniques.

In the case of melanoma, eradication of the lesion may require local lymph node removal. The best treatment should be based on early removal of pre-malignant lesions or nevi, which may present clinical alterations suggesting incipient malignancy.

The node is the first place affected in metastasis or extension of the disease to other organs. Therefore, it is indicated within the surgical treatment to perform the removal of the sentinel lymph node, which due to its anatomical location would be the first to be affected in the event of metastasis. It is key to healing.

Since melanoma has a relapse rate of 50-80%, chemotherapy is given as an adjuvant treatment to prevent relapses.

In high-risk patients with advanced stage melanoma, treatment with high doses of interferon alpha2b is indicated, the only treatment shown to improve disease-free survival.

It can cause side effects, such as tiredness, alterations in liver enzymes, bone marrow depression, etc., but the benefits obtained outweigh these side effects which, with the proper medical supervision, do not cause the patient any serious problems.

When the melanoma has spread to other organs and causes metastasis, the purpose of the treatments will be palliative. The most commonly used chemotherapy in these cases is the administration of a single chemotherapy drug, dacarbazine, which achieves an approximate response of 20%, although generally of short duration.

Radiation therapy is usually not indicated in the treatment of melanoma.

In these cases, it can be administered with palliative effect, mainly to control painful bone metastases that compress the bone marrow, or in brain metastases.

Immunotherapy is a treatment that aims to improve and stimulate the patient's own immune system to recognize and destroy malignant cells more effectively.

Personalized vaccines

In the GMP Laboratory of the Clínica Universidad de Navarra, autologous dendritic cells are produced, loaded with the patient's own tumor antigens, for their application in this clinical trial of the Program of Cancer Immunology and Gene Therapy.

It is aimed at the treatment of patients with various cancers, including malignant melanoma. In this line, the vaccines can open a door to hope in the future treatment of disseminated melanoma.

A multidisciplinary team of renowned prestige being at the forefront

AT THE FOREFRONT

Advanced Therapy Unit

The Advanced Therapies Unit of Clínica Universidad de Navarra has been established in order to deal exclusively with cellular therapies against cancer and other diseases of the immune system, favouring their administration and seeking to increase the safety of these treatments.

A multidisciplinary team of highly specialised nurses together with physicians from all the specialities involved in the approach to those treatments that depend on advanced therapy drugs and immunotherapy

Where do we treat it?

IN NAVARRE AND MADRID

The Department of Dermatology
of the Clínica Universidad de Navarra

The Department of Dermatology of the Clinica Universidad de Navarra has extensive experience in the diagnosis and treatment of dermatological diseases.

We have extensive experience in highly precise surgical treatments, such as Mohs surgery. This procedure requires highly specialized personnel. 

We have the latest technology for the dermo-aesthetic treatment of skin lesions, with the aim of achieving the best results for our patients.

Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Experts in Mohs Surgery for the treatment of skin cancer.
  • We have the best technology for dermo-aesthetic treatments.
  • Safety and quality assurance of the best private hospital in Spain.

Safer than ever to continue taking care of you

We update safety protocols weekly with the latest scientific evidence and the knowledge of the best international centers with which we collaborate.